Healthcare Provider Details

I. General information

NPI: 1528140969
Provider Name (Legal Business Name): RAYMOND PAUL JONES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE
FORT LEAVENWORTH KS
66027-2332
US

IV. Provider business mailing address

7404 NW 85TH TER
KANSAS CITY MO
64153-3700
US

V. Phone/Fax

Practice location:
  • Phone: 913-684-6442
  • Fax:
Mailing address:
  • Phone: 816-505-3573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number112035
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: